open access
Potential alternative treatment approach for pediatric patient with diffusely infiltrative primary rhabdomyosarcoma of the liver
open access
Abstract
Primary hepatic rhabdomyosarcoma is rare, making decisions regarding locoregional management with resection and/or conventional radiation difficult. We present a novel treatment approach for a pediatric patient diagnosed with rhabdomyosarcoma diffusely involving the liver. This patient underwent treatment with yttrium-90 (Y-90) microspheres followed by external beam radiation therapy (EBRT) to residual disease, interdigitated with systemic chemotherapy. Initial post-radiation imaging showed significant response to treatment, and she experienced minimal acute toxicities and no long-term toxicities. She developed recurrent PET-avid disease 23 months after Y-90 treatment, necessitating further local and continued systemic therapies. We report on the tumor control following Y-90 and EBRT treatment.
Abstract
Primary hepatic rhabdomyosarcoma is rare, making decisions regarding locoregional management with resection and/or conventional radiation difficult. We present a novel treatment approach for a pediatric patient diagnosed with rhabdomyosarcoma diffusely involving the liver. This patient underwent treatment with yttrium-90 (Y-90) microspheres followed by external beam radiation therapy (EBRT) to residual disease, interdigitated with systemic chemotherapy. Initial post-radiation imaging showed significant response to treatment, and she experienced minimal acute toxicities and no long-term toxicities. She developed recurrent PET-avid disease 23 months after Y-90 treatment, necessitating further local and continued systemic therapies. We report on the tumor control following Y-90 and EBRT treatment.
Keywords
yttrium-90; external beam radiation therapy; pediatrics; rhabdomyosarcoma
About this articleTitle
Potential alternative treatment approach for pediatric patient with diffusely infiltrative primary rhabdomyosarcoma of the liver
Journal
Reports of Practical Oncology and Radiotherapy
Issue
Article type
Case report
Pages
143-148
Published online
2021-01-22
DOI
10.5603/RPOR.a2021.0008
Bibliographic record
Rep Pract Oncol Radiother 2021;26(1):143-148.
Keywords
yttrium-90
external beam radiation therapy
pediatrics
rhabdomyosarcoma
Authors
Rushil Patel
John Roberson
Devina Prakash
Rina Meyer
Laura Hogan
Christeen Azmy
Valmore Suprenant
Samuel Ryu
Alexander Stessin
References (19)- Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, et al. SEER Cancer Statistics Review, 1975–2017, National Cancer Institute. Bethesda, MD. https://seer.cancer.gov/csr/1975_2017/ (September 10, 2020).
- Gartrell J, Pappo A. Recent advances in understanding and managing pediatric rhabdomyosarcoma. F1000Res. 2020; 9.
- Crist W, Gehan EA, Ragab AH, et al. The Third Intergroup Rhabdomyosarcoma Study. J Clin Oncol. 1995; 13(3): 610–630.
- Bierman HR, Byron RL, Kelley KH, et al. Studies on the blood supply of tumors in man. III. Vascular patterns of the liver by hepatic arteriography in vivo. J Natl Cancer Inst. 1951; 12(1): 107–131.
- Wang EA, Broadwell SR, Bellavia RJ, et al. Selective internal radiation therapy with SIR-Spheres in hepatocellular carcinoma and cholangiocarcinoma. J Gastrointest Oncol. 2017; 8(2): 266–278.
- Llovet JM, Ricci S, Mazzaferro V, et al. SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008; 359(4): 378–390.
- Mosconi C, Cappelli A, Pettinato C, et al. Radioembolization with Yttrium-90 microspheres in hepatocellular carcinoma: Role and perspectives. World J Hepatol. 2015; 7(5): 738–752.
- Riaz A, Awais R, Salem R. Side effects of yttrium-90 radioembolization. Front Oncol. 2014; 4: 198.
- Aguado A, Ristagno R, Towbin AJ, et al. Transarterial radioembolization with yttrium-90 of unresectable primary hepatic malignancy in children. Pediatr Blood Cancer. 2019; 66(7): e27510.
- Kennedy AS, McNeillie P, Dezarn WA, et al. Treatment parameters and outcome in 680 treatments of internal radiation with resin 90Y-microspheres for unresectable hepatic tumors. Int J Radiat Oncol Biol Phys. 2009; 74(5): 1494–1500.
- Wang TH, Huang PI, Hu YW, et al. Combined Yttrium-90 microsphere selective internal radiation therapy and external beam radiotherapy in patients with hepatocellular carcinoma: From clinical aspects to dosimetry. PLoS One. 2018; 13(1): e0190098.
- Common terminology criteria for adverse events (CTCAE) v5. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf. (June 2, 2020).
- Lewandowski RJ, Geschwind JF, Liapi E, et al. Transcatheter intraarterial therapies: rationale and overview. Radiology. 2011; 259(3): 641–657.
- D'Avola D, Lñarrairaegui M, Bilbao JI, et al. A retrospective comparative analysis of the effect of Y90-radioembolization on the survival of patients with unresectable hepatocellular carcinoma. Hepatogastroenterology. 2009; 56(96): 1683–1688.
- Lewandowski RJ, Kulik LM, Riaz A, et al. A comparative analysis of transarterial downstaging for hepatocellular carcinoma: chemoembolization versus radioembolization. Am J Transplant. 2009; 9(8): 1920–1928.
- Salem R, Lewandowski RJ, Mulcahy MF, et al. Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: a comprehensive report of long-term outcomes. Gastroenterology. 2010; 138(1): 52–64.
- Hawkins CM, Kukreja K, Geller JI, et al. Radioembolisation for treatment of pediatric hepatocellular carcinoma. Pediatr Radiol. 2013; 43(7): 876–881.
- Grigorian A, O'Brien CB. Hepatotoxicity Secondary to Chemotherapy. J Clin Transl Hepatol. 2014; 2(2): 95–102.
- Marks LB, Yorke ED, Jackson A, et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys. 2010; 76(3 Suppl): S10–S19.